J Korean Pediatr Soc.  2003 Jun;46(6):576-584.

Henoch-Scholein Purpura Presenting with Acute Abdominal Pain Preceding Skin Rash: Review of 23 Cases

• Chang JY
• Kim YJ
• Kim KS
• Kim HJ
• Seo JK

Abstract

PURPOSE
For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash.
METHODS
The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed.
RESULTS
The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year.
CONCLUSION
The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.

Keyword

Henoch Scholein purpura; Duodenitis; Endoscopy; Ultrasonogram; Acute abdominal pain

MeSH Terms

Abdomen, Acute
Abdominal Pain*
Diagnosis
Duodenitis
Duodenum
Early Diagnosis
Endoscopy
Exanthema*
Gastrointestinal Hemorrhage
Hemorrhage
Nephritis
Purpura*
Recurrence
Sigmoidoscopy
Skin*
Ulcer
Ultrasonography